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Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution

  • Lee, Jeong Won (Department of Radiation Oncology, Catholic University of Daegu, School of Medicine) ;
  • Lee, Jeong Eun (Department of Radiation Oncology, School of Medicine, Kyungpook National University) ;
  • Park, Junhee (Department of Radiation Oncology, School of Medicine, Kyungpook National University) ;
  • Sohn, Jin Ho (Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University) ;
  • Ahn, Dongbin (Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University)
  • Received : 2019.03.04
  • Accepted : 2019.06.17
  • Published : 2019.06.30

Abstract

Purpose: To evaluate the results of hypofractionated radiotherapy (HFX) for early glottic cancer. Materials and Methods: Eighty-five patients with cT1-2N0M0 squamous cell carcinoma of the glottis who had undergone HFX, performed using intensity-modulated radiotherapy (IMRT, n = 66) and three-dimensional conformal radiotherapy (3D CRT, n = 19) were analyzed. For all patients, radiotherapy was administered at 60.75 Gy in 27 fractions. Forty-three patients received a simultaneous integrated boost (SIB) of 2.3-2.5 Gy per tumor fraction. Results: The median follow-up duration was 29.9 months (range, 5.5 to 76.5 months). All patients achieved complete remission at a median of 50 days after the end of radiotherapy (range, 14 to 206 days). The 5-year rates for locoregional recurrence-free survival was 88.1%, and the 5-year overall survival rate was 86.2%. T2 stage was a prognostic factor for locoregional recurrence-free survival after radiotherapy (p = 0.002). SIB for the tumor did not affect disease control and survival (p = 0.191 and p = 0.387, respectively). No patients experienced acute or chronic toxicities of ≥grade 3. IMRT significantly decreased the dose administered to the carotid artery as opposed to 3D CRT (V35, p < 0.001; V50, p < 0.001). Conclusions: Patients treated with HFX achieved acceptable locoregional disease control rates and overall survival rates compared with previous HFX studies. A fraction size of 2.25 Gy provided good disease control regardless of SIB administration.

References

  1. Mendenhall WM, Amdur RJ, Morris CG, Hinerman RW. T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J Clin Oncol 2001;19:4029-36.
  2. Lim YJ, Wu HG, Kwon TK, et al. Long-term outcome of definitive radiotherapy for early glottic cancer: prognostic factors and patterns of local failure. Cancer Res Treat 2015;47:862-70.
  3. Smee RI, Meagher NS, Williams JR, Broadley K, Bridger GP. Role of radiotherapy in early glottic carcinoma. Head Neck 2010;32:850-9.
  4. Mendenhall WM, Parsons JT, Million RR, Fletcher GH. T1-T2 squamous cell carcinoma of the glottic larynx treated with radiation therapy: relationship of dose-fractionation factors to local control and complications. Int J Radiat Oncol Biol Phys 1988;15:1267-73.
  5. Rudoltz MS, Benammar A, Mohiuddin M. Prognostic factors for local control and survival in T1 squamous cell carcinoma of the glottis. Int J Radiat Oncol Biol Phys 1993;26:767-72.
  6. Schwaibold F, Scariato A, Nunno M, et al. The effect of fraction size on control of early glottic cancer. Int J Radiat Oncol Biol Phys 1988;14:451-4.
  7. Ermis E, Teo M, Dyker KE, Fosker C, Sen M, Prestwich RJ. Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions. Radiat Oncol 2015;10:203.
  8. Gowda RV, Henk JM, Mais KL, Sykes AJ, Swindell R, Slevin NJ. Three weeks radiotherapy for T1 glottic cancer: the Christie and Royal Marsden Hospital Experience. Radiother Oncol 2003;68:105-11.
  9. Le QT, Fu KK, Kroll S, et al. Influence of fraction size, total dose, and overall time on local control of T1-T2 glottic carcinoma. Int J Radiat Oncol Biol Phys 1997;39:115-26.
  10. Yamazaki H, Nishiyama K, Tanaka E, Koizumi M, Chatani M. Radiotherapy for early glottic carcinoma (T1N0M0): results of prospective randomized study of radiation fraction size and overall treatment time. Int J Radiat Oncol Biol Phys 2006;64:77-82.
  11. Yu E, Shenouda G, Beaudet MP, Black MJ. Impact of radiation therapy fraction size on local control of early glottic carcinoma. Int J Radiat Oncol Biol Phys 1997;37:587-91.
  12. Berwouts D, Swimberghe M, Duprez F, et al. Intensitymodulated radiotherapy for early-stage glottic cancer. Head Neck 2016;38 Suppl 1:E179-84.
  13. Martin JD, Buckley AR, Graeb D, Walman B, Salvian A, Hay JH. Carotid artery stenosis in asymptomatic patients who have received unilateral head-and-neck irradiation. Int J Radiat Oncol Biol Phys 2005;63:1197-205.
  14. Fein DA, Lee WR, Hanlon AL, Ridge JA, Curran WJ, Coia LR. Do overall treatment time, field size, and treatment energy influence local control of T1-T2 squamous cell carcinomas of the glottic larynx? Int J Radiat Oncol Biol Phys 1996;34:823-31.
  15. Kim TG, Ahn YC, Nam HR, et al. Definitive radiation therapy for early glottic cancer: experience of two fractionation schedules. Clin Exp Otorhinolaryngol 2012;5:94-100.
  16. Moon SH, Cho KH, Chung EJ, et al. A prospective randomized trial comparing hypofractionation with conventional fractionation radiotherapy for T1-2 glottic squamous cell carcinomas: results of a Korean Radiation Oncology Group (KROG-0201) study. Radiother Oncol 2014;110:98-103.
  17. Bledsoe TJ, Park HS, Stahl JM, et al. Hypofractionated radiotherapy for pat ients with ear ly-stage glottic cancer: patterns of care and survival. J Natl Cancer Inst 2017;109:djx042. https://doi.org/10.1093/jnci/djx042
  18. Cheah NL, Lupton S, Marshall A, Hartley A, Glaholm J. Outcome of T1N0M0 squamous cell carcinoma of the larynx treated with short-course radiotherapy to a total dose of 50 Gy in 16 fractions: the Birmingham experience. Clin Oncol (R Coll Radiol) 2009;21:494-501.
  19. van der Voet JC, Keus RB, Hart AA, Hilgers FJ, Bartelink H. The impact of treatment time and smoking on local control and complications in T1 glottic cancer. Int J Radiat Oncol Biol Phys 1998;42:247-55.
  20. Dinshaw KA, Sharma V, Agarwal JP, Ghosh S, Havaldar R. Radiation therapy in T1-T2 glottic carcinoma: influence of various treatment parameters on local control/complications. Int J Radiat Oncol Biol Phys 2000;48:723-35.
  21. Leclerc M, Maingon P, Hamoir M, et al. A dose escalation study with intensity modulated radiation therapy (IMRT) in T2N0, T2N1, T3N0 squamous cell carcinomas (SCC) of the oropharynx, larynx and hypopharynx using a simultaneous integrated boost (SIB) approach. Radiother Oncol 2013;106:333-40.
  22. Rastogi M, Sapru S, Gupta P, et al. Prospective evaluation of intensity modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) in head and neck squamous cell carcinoma in patients not suitable for chemo-radiotherapy. Oral Oncol 2017;67:10-6.
  23. Janssen S, Glanzmann C, Huber G, Studer G. Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer. Radiat Oncol 2014;9:136.
  24. Laskar SG, Baijal G, Murthy V, et al. Hypofractionated radiotherapy for T1N0M0 glottic cancer: retrospective analysis of two different cohorts of dose-fractionation schedules from a single institution. Clin Oncol (R Coll Radiol) 2012;24:e180-6.
  25. Olszewski SJ, Vaeth JM, Green JP, Schroeder AF, Chauser B. The influence of field size, treatment modality, commissure involvement and histology in the treatment of early vocal cord cancer with irradiation. Int J Radiat Oncol Biol Phys 1985;11:1333-7.
  26. Onimaru R, Hasegawa M, Yasuda K, et al. Radiotherapy for glottic T1N0 carcinoma with slight hypofractionation and standard overall treatment time: importance of overall treatment time. Jpn J Clin Oncol 2011;41:103-9.
  27. Chera BS, Amdur RJ, Morris CG, Kirwan JM, Mendenhall WM. T1N0 to T2N0 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy. Int J Radiat Oncol Biol Phys 2010;78:461-6.
  28. Swisher-McClure S, Mitra N, Lin A, et al. Risk of fatal cerebrovascular accidents after external beam radiation therapy for early-stage glottic laryngeal cancer. Head Neck 2014;36:611-6.
  29. Hong JC, Kruser TJ, Gondi V, et al. Risk of cerebrovascular events in elderly patients after radiation therapy versus surgery for early-stage glottic cancer. Int J Radiat Oncol Biol Phys 2013;87:290-6.
  30. Smith GL, Smith BD, Buchholz TA, et al. Cerebrovascular disease risk in older head and neck cancer patients after radiotherapy. J Clin Oncol 2008;26:5119-25.
  31. Gujral DM, Long M, Roe JW, Harrington KJ, Nutting CM. Standardisation of target volume delineation for carotidsparing intensity-modulated radiotherapy in early glottis cancer. Clin Oncol (R Coll Radiol) 2017;29:42-50.
  32. Choi HS, Jeong BK, Jeong H, et al. Carotid sparing intensity modulated radiotherapy on early glottic cancer: preliminary study. Radiat Oncol J 2016;34:26-33.
  33. Kim YS, Lee J, Park JI, Sung W, Lee SM, Kim GE. Volumetric modulated arc therapy for carotid sparing in the management of early glottic cancer. Radiat Oncol J 2016;34:18-25.
  34. Matthiesen C, Herman T, Singh H, et al. Dosimetric and radiobiologic comparison of 3D conformal, IMRT, VMAT and proton therapy for the treatment of early-stage glottic cancer. J Med Imaging Radiat Oncol 2015;59:221-8.